Health-care act aims to catch illness early

Wednesday

Aug 29, 2012 at 2:00 AM

Editor's note: This is the first in a two-part series on the Affordable Care Act.

Editor's note: This is the first in a two-part series on the Affordable Care Act.

Preventive care. That was Bill Massidda's short answer to a question I asked about the Patient Protection and Affordable Care Act (ACA); what some people have called Obamacare. Massidda is a retired actuary, a businessman who throughout his long career has dealt with the financial impact of risks and uncertainty. He was president of an employee benefits management company before retiring in 1998.

The law's length — the full text is 2,400 pages long — makes it difficult to know what to think about the ACA. Is it, I wondered, as protective and affordable as its name suggests? I figured I needed to talk to someone who was neither a detractor nor a booster; someone who could help me grasp the implications of this complex and controversial new law. Massidda has studied the ACA, going so far as to listen to more than 40 hours of conversation last April between lawyers representing each side of the issue and the Supreme Court justices who decided in June that the ACA was constitutional. He's definitely the man to ask about the ACA.

First, what do people mean when they talk about preventive care? Generally, preventive care refers to evidence-based medicine that relies on screenings, counseling services and preventive medications. The preventive care model complements the traditional curative care model, which typically responds only after illnesses have developed.

"If you just think about three major diseases," Massidda said, "you'll understand the tremendous impact which the preventive care provisions of the ACA are going to have." He was talking about the economic impacts of cardiovascular disease (heart attack and stroke), diabetes and cancer; medical conditions that account for more than 50 percent of all deaths in this country every year. Each of these diseases is much more expensive to treat as an advanced medical condition than it is to prevent, to detect and to treat if found early enough.

Preventive care saves lives, but when people don't have health insurance they often do not seek, nor do they receive, preventive care. Uninsured people don't get the tests that allow for early (and relatively inexpensive) treatment because such tests are out of pocket and often unaffordable. The ACA changes all that by requiring that all private insurance policies cover a slew of preventive services from annual wellness visits to prenatal care; from blood pressure tests to mammograms; from flu shots to diabetes screenings — all without co-payment or deductibles. It is worth noting that the ACA also prohibits companies from denying coverage because of pre-existing conditions, patient age, health status or lifetime dollar limitations. That sure sounds like patient protection.

To understand the ACA you also need to know about the Emergency Medical Treatment and Active Labor Act (EMTALA) which President Reagan signed into law in 1986. EMTALA requires hospitals and ambulance services to provide emergency treatment to people regardless of their insurance status or ability to pay. Who pays for this care? If you have health insurance, you do. In other words, everyone with health insurance pays for uninsured people to be treated for medical emergencies. Studies have shown that when health insurance policy holders receive preventive care, there is a significant reduction in both the size and the number of medical claims.

Consider the case of colorectal cancer — the second leading cause of cancer death in the United States and the nation's third most common malignancy — in which symptoms often occur too late for early intervention. Under the ACA, colorectal cancer screening will be routine and the potential savings enormous. The aggregate cost for treating colorectal cancer in this country is more than $14 billion annually. Catch this cancer early and the bills for its treatment will go down dramatically. Preventive care and its array of rapidly advancing technologies for screening and treating diseases is a boon to everyone who participates.

Massidda noted that people who have health insurance and the companies for whom they work currently contribute somewhere between $30 billion and $70 billion annually for emergency medical treatment of uninsured people who are sick. The ACA's provisions will dramatically reduce the need for this expense — a hidden tax, Massidda calls it.

I came away from our conversation agreeing that the law is suitably titled. Preventive care, with its emphasis on evidence-based medicine and technology, is poised to deliver on its dual promises of patient protection and affordable care. An ounce of prevention just may be worth a pound of cure.

Next time, the individual mandate.

Ron McAllister is a sociologist and writer who lives in York. He is currently a candidate for the Maine House of Representatives.

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